Ambulance utilization versus selftransportation in acute coronary syndrome: characteristics and reasons

Background: Timely activation of emergency medical services (EMS) is a critical determinant of outcomes in acute coronary syndrome (ACS), yet utilization rates vary widely across regions. This study examines ambulance use among ACS patients presenting to a major emergency department in Kuwait, with the aim of identifying patterns, influencing factors, and patient-reported reasons for choosing ambulance transport over self-transport. Methods: A prospective cross-sectional survey was conducted from February to May 2025 at Farwaniya Hospital. Adult patients diagnosed with ACS and admitted within 24 hours were enrolled. Sociodemographic, clinical, and transport-related data were collected via structured questionnaires and electronic medical records. Descriptive and inferential analyses were performed to assess associations between transport mode and key variables. Results:  Of 413 enrolled patients, only 134 (34.4%) arrived by ambulance, whereas 279 (67.6%) used self-transport. Age, gender, nationality, marital status, comorbidities, education, and final diagnosis showed no significant association with transport mode. Ambulance use was higher on Wednesdays and Thursdays (p = 0.004) and during daytime hours (7:00 am-3:00 pm) (p = 0.008). Although only 1.4% of patients were aware of national ACS awareness messaging, perceived illness severity strongly influenced transport choice; 80.6% of ambulance users considered their condition serious. Self-transport was commonly chosen due to perceived speed and convenience (76.3% and 38.7%, respectively). Physician advice was associated with increased ambulance use, whereas advice from family/friends was associated with increased self-transportation. Conclusion: Ambulance utilization among ACS patients in Kuwait requires considerable improvement despite existing guideline recommendations and recent awareness-raising initiatives. Transport decisions appear to be driven primarily by patient perceptions rather than by clinical or demographic factors. Enhancing EMS awareness, increasing physician-led education, and delivering targeted public health campaigns may help improve timely EMS activation and reduce prehospital delays.